One Stage Flexor Tendon Reconstruction and Early Motion for Old Flexor Tendon Injuries Zone II / 대한정형외과학회잡지

Since 1985, authors have applied a cast ring around the reconstructed pully involving adjacent one normal digit and allowed early dynamic motion after one stage tenolysis or tendon graft in 24 digits of 16 patients with old flexor tendon injuries in zone II. With this ring technique, authors obtained satisfactory results in 80% of the patients, which proved to be as good as two stage flexor tendon reconstruction with silicone rodding. A cast ring allowed early active motion after tenolysis and early dynamic passive motion after tendon graft. It served as temporary external augmentation of the reconstructed pully and seemed to reduce the tension at the reconstruced tendon and pully. One stage flexor tendon reconstruction and early dynamic motion with ring technique was advantageous in shortening of morbidity and postoperative rehabilitation period, and eliminating complications from silicone rodding.

An Application of the Ultrasonograhy to the Musculoskeletal Masses / 대한정형외과학회잡지

Ultrasonography is suited for screening patients with a mass in the soft tissue because of its safety, low cost, apparent sensitivity and non-invasiveness. But the application in orthopaedic surgery is insufficient. Authors examined 102 patients who had a palpable soft tissue mass of extremities and trunk with ultrasonography. Location, internal echogenicity, margin, and extent of soft tissue involvement, especially neurovascular bundle by tumor were evaluated. The diagnosis of mass was confirmed by histopathology after excision or biopsy of the mass. The ultrasonography correctly identified and differentiated the cystic lesions of 34 cases. The sonograms of all 16 malignant lesions showed ill-defined margin and heterogenous internal echo. The extent of soft tissue involvement, especially neurovascular bundle was confirmed exactly with ultrasonography. Therefore, in malignant tumor, after confirmation of no neurovascular involvemment with ultrasonography, limb-salvage operation could be considered and planned. In one case of abscess, percutaneous biopsy was done under guidance of ultrasonography. Therefore, ultrasonography can be used as a guide for percutaneous biopsy without exposure to radiation.

Experimentally Induced Osteoporosis after Segmental Resection of Nerves, Muscles and Tendons in Rats' Tibiae / 대한정형외과학회잡지

We carried out animal experiment in order to determine the effect of resection of nerves, muscles and tendons on the induction of osteoporosis. One hundred and forty rats, weighing approximately 250 gm, were divided into seven groups. In Group I, as a control group, the three skin incisions, one on the anterior aspect of the knee, one on the anteromedial aspect of proximal thigh, and one on the posterior aspect of proximal thigh were made and wounds were sutured. In Group II, the patellar tendon and the extensor digitorum longus tendon were divided to disable knee extension. In Group III, all the knee flexors were divided. In Group IV, all the knee extensors and flexors were divided. In Group V, the femoral nerve was divided to disable knee extension. In Group VI, the sciatic and obturator nerves were divided to diable knee flexion. In Group VII, the sciatic, and obtrator nerves were all divided. Before the procedures, bone density was measured by photon absorptiometry and postoperatively, the measurement was repeated every two weeks until the eighth week. At the time of each measurement, two rats were sacrificed out of each group and were submitted to microphotographic measurement of the tibial cortices. The results were as follows. l. In the muscle and tendon resection groups (Group II, Group III, Group IV), the bone density significantly decreased two weeks after operation and then, gradually increased four, six and eight weeks. 2. In the nerve resection groups (Group V, Group VI, and Group VII), the bone density decreased significantly two and four weeks after operation and then gradually increased six, and eight weeks after operation. 3. In both motor resection and denervation, the paralysis of both flexors and extensors of the knee, caused more decrease in bone density than the paralysis of either flexor or extensor. 4. In the muscle and tendon resection groups, the bone density was significantly more decrease two weeks after operation when the flexors were resected, but thereafter there was no significant difference between the flexors and extensors resection. In the nerve resection group, the paralysis of knee flexors caused more decrease in bone density than the paralysis of knee extensors throughout the entire experimental period. 5. The nerve resection groups demonstrated significantly more severe loss of bone density than muscle and tendon resection groups throughout the entire experimental period. 6. The values of bone density measured by photon absorptiometry correlated well with the cortical thickness indices. Bssed upon these observations, we came to the following conclusions. 1. The osteoporosis following injuries of the nerve, muscle, and tendon is most significant at two weeks after injury. 2. Denervation causes more severe osteoporosis than muscle and tendon injuries. 3. It is suggested that the photon absorptiometry is a reliable means in the evaluation of the osteoporosis.